Start with down and out (3)
I believe the answer is:
rub
'start with down and out' is the definition.
(I've seen this in another clue)
This is the entire clue.
(Other definitions for rub that I've seen before include "Ointment; chief difficulty" , "Polish or massage" , "Apply friction to - difficulty" , "Massage or burnish" , "Central difficulty" .)